In a previous controlled group outcome study, a comparison of temperature biofeedback with progressive relaxation indicated that relaxation training was more effective in reducing migraine headache activity at the end of treatment. However, follow-up data obtained at 1, 2, and 3 months after the completion of treatment showed no difference between the two groups on any dependent measure. In the current study, 18 of 26 subjects who completed treatment in the original investigation collected headache data and completed a headache questionnaire I year subsequent to the conclusion of treatment in order to evaluate the long-term effectiveness of the two treatments. The results indicated that gains achieved in the reduction of headaches during both treatments were maintained at a 1-year follow-up. With the exception of medication consumption (for which relaxation training led to better long-term results) the 1-year follow-up data reveal no differential efficacy for temperature biofeedback or progressive relaxation in treating migraine headaches.

A historical perspective regarding research and treatment of the migraine syndrome and the studies in animals and humans relating to control of the autonomic nervous system is given. Pilot experience with 75 subjects is presented, and a detailed clinical account of one successful subject with pertinent research records in given. Reference is made to the implications of this clinical research to psychosomatic medicine.

At one time, biofeedback and behavioral medicine were considered synonymous, as evidence by Birk’s 1973 book, Biofeedback: Behavioral Medicine. As is obvious from the contents of this present book, behavioral medicine encompasses much, much more than biofeedback. However, as pointed out by Blanchard (1977), biofeedback is one important aspect of behavioral medicine. Much of behavioral medicine is concerned with changing gross, observable behavior. This can be accomplished either as direct treatment of a disorder with demonstrable pathophysiology, such as the treatment of obesity through modifying eating behavior and exercise patterns, or as an adjunct to standard medical treatment, such as improving medication-taking compliance in the drug treatment of hypertension. Biofeedback is somewhat different in that it represents psychological intervention delivered directly at the physiological level rather than at the level of gross motor behavior. Thus, in a sense, biofeedback could be seen as applied, or clinical, psychophysiology.

Disease patterns in Western countries have shifted dramatically in the last century. In 1900, the leading causes of death tended to be infectious diseases; however, by mid-century they had become chronic diseases. For example, in 1968, the likelihood of dying from an infectious disease was one-sixth what it was in 1900, but the death rate from heart disease had increased by 268%. Current predictions indicate that over 80% of the male children born this year will eventually die of chronic diseases (Glazier, 1973). Moreover, chronic diseases are on the increase among the young as well as the old (Erhardt & Berlin, 1974; National Center for Health Statistics, 1977).

Although migraine headaches are less prevalent than tension headaches, patients suffering from migraines report that the pain is more severe and may be associated with nausea or other physical complaints. The pulsatile pain is usually located on one side of the forehead and appears to be the consequence of dilation in the superficial temporal arteries. Although there is debate as to the cause of migraine, the vascular locus of the pain is readily apparent, as the forehead blood vessels may protrude during migraine attacks (Dalessio, 1972). Migraines are generally treated with prescription medications, particularly ergotamine tartrate, a vasoconstrictor. Drug treatment is successful for many individuals, but pharmacological agents do not work in all cases and may cause severe side effects for some patients (Diamond & Furlong, 1976).

The published reports on clinical applications of biofeedback training are summarized and critically reviewed. Only in the area of electromyogram feedback for muscle retraining, elimination of subvocal speech while reading, and elimination of tension headaches does the evidence support strong conclusions on the efficacy of biofeedback training.

This chapter concerns itself with the application of learning techniques to the remediation of disease. Although the idea of teaching people to control their physiology can be traced back to antiquity, learned control of visceral responses and other involuntary functions has only recently come under systematic investigation by psychologists. This research has developed techniques that, for the first time, have enabled therapists to place the physiological activity of the body under the control of environmental contingencies, in much the same way as has been done with other types of behavior. In essence, it now seems feasible to extend the scope of behavior modification into the domain of medicine.

Two young girls with a history of headaches were trained with autogenic training phrases and with thermal biofeedback training. Subject L.S. (age 9) had suffered serious spells of vertigo complicated with nausea since the age of 3. which by the age of 5 increasingly transformed itself into a typical migraine. Subject J.C. (age 13) had had recurrent headaches since the age of 5; they were often bilateral and included nausea and vomiting (not a typical childhood migraine). Both girls rapidly learned to control their peripheral temperature in two training sessions while practicing for 3 weeks at home and at school with and without equipment; both have been symptom-free (without medication) for the last 6 months. Unlike adults, in whom training must first remove the accumulated self-destructive patterns, both girls learned very rapidly and accepted this as a natural process This learning process may foster a shift in health attitudes from helplessness to self-responsibility.

Summary

Microembolization from an ulcerated carotid artery to both occipital lobes via a persistent trigeminal artery was observed in a patient presenting with episodic bilateral central scotomata. Symptomatic relief was obtained following carotid endarterectomy. This unique pathway which resulted in occipital lobe ischemia has not been previously reported.